Organization
ACTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHERINE L GRIDLEY MA, CCC-SLP (SLP-OWNER)
(678) 481-3500
Entity
Organization
Contact information
Practice address
500 LANIER AVE W STE 702, FAYETTEVILLE, GA 30214-7643
(678) 481-3500
Mailing address
500 LANIER AVE W STE 702, FAYETTEVILLE, GA 30214-7643
(678) 481-3500
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
SLP001692
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003156050A
—
GA
Enumeration date
02/07/2017
Last updated
02/07/2017
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